QUALITY ASSURANCE MANAGER - 64256

Executive Service

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

This position requires a background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview:

The Division of TennCare is seeking a Quality Assurance Manager in the Quality Assurance Unit in the Eligibility Operations Group within Member Services. They will work under immediate supervision of the Quality Assurance Director. This role will manage a team of TennCare Program Coordinators and other levels of staff who will utilize the TennCare Eligibility Determination System (TEDS) to process applications and determine eligibility for Institutional Medicaid. The Quality Assurance Manager will ensure that staff communicate with applicants, members, families, facilities, and Authorized Representatives to relay clear information and expectations of the information needed for an accurate eligibility determination.

Additionally, this position will be responsible for monitoring case quality and productivity of their staff. The Quality Assurance Manager will assist with unit goals, priorities, objectives and strategies as well as ensure communication and action plans are efficiently and effectively implemented within their area of responsibility. The Quality Assurance Manager will collaborate on problem solving and decision-making processes among their peers within Member Services. This position will work collaboratively and proactively with the Quality Assurance Director to identify areas of concern and create continuous quality and process improvement plans. The Quality Assurance Manager will have a working knowledge of case evaluation related to resolution of cases from internal and external partners. Lastly, the Quality Assurance Manager must maintain a current knowledge base of policy and regulations surrounding Medicaid.

Key Responsibilities:

• Supervise a team of TennCare Program Coordinators and other levels of staff
• Provide support and guidance to staff on matters relating to Medicaid rules, regulations, policies and procedures
• Conduct weekly team meetings to provide timely information regarding processes, initiatives, directives, and training opportunities, as well as discuss staff ideas for continuous work process improvement
• Provide clear and concise verbal and written communication and guidance to staff in a positive manner
• Ensure all tasks are processed within the designated timeframe by monitoring, assessing, and addressing the team's overall performance
• Monitor staff production and quality by reviewing team performance reports and performing required case reads
• Conduct regular coaching and guidance to ensure staff are meeting goals set forth by the agency and in compliance with TennCare policy and following established business processes
• Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of opportunity are resolved in a positive manner - Utilize Edison to monitor leave balances, approve/deny leave requests and approving payable time
• Conduct monthly conferences timely and utilize the required written format
• Utilize the SMART formula to evaluate/rate employee performance throughout the performance review cycle
• Build team morale to ensure staff have a positive and inclusive work environment; which leads to higher job satisfaction, and results in greater team efficiencies and effectiveness

Minimum Qualifications:

Education and Experience: Graduation from an accredited college or university with a bachelor's degree and experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, managed Care, or other related health insurance organization, of which two years must include drafting contractual requirements, developing rules and regulations, or supervising staff who deal with health insurance.

Substitution of Experience for Education: Five years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, and/or Managed Care Division Director with the State of Tennessee, of which one year must be at the Managed Care Specialist 3 or higher level.

OR

an equivalent combination of education and work experience may be considered

Desirable qualifications:

• Graduation from an accredited college or university with a bachelor's degree and/or experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization, or supervising professional staff who deal with health insurance
• Ability to foster and maintain cohesive working relationships
• Ability to interpret and execute policies and procedures
• Strong organizational skills, with proven ability to prioritize, multi-task, adapt to changing priorities or deadlines, and manage workload to meet specific timeframes
• Ability to take initiative with tasks
• Ability to be flexible and accountable
• Ability to coach and mentor a diverse workforce
• Demonstrate passion and commitment
• Advanced research skills, including the ability to locate and analyze documents and integrate information from multiple sources
• Advanced customer service skills, including the ability to problem solve, handle difficult situations, and escalate issues when necessary
• Strong work ethic with an ability to receive and implement constructive feedback
• Advanced writing and communication skills
• Ability to learn quickly and exercise sound judgement

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.